I spent the day today with 60 physicians and nurses at a symposium focused on quality improvement and reducing mortality from sepsis. Sepsis (overwhelming infection) is the number 1 cause of hospital deaths and the mortality rate can be as high as 60% if the patient goes into shock from infection. Survival depends upon thousands of independent pieces coming together in an organized way. A patient doesn’t come to the emergency department and say “I have sepsis”. He may arrive by ambulance or be brought in by a relative and simply feel weak, or confused or have a fever.

To make the diagnosis, the doctor or nurse has to be thinking sepsis is a possibility and it is critical to get the right tests and treatments within a very short time frame. There are complicated steps that must be taken quickly and the entire hospital team (lab, pharmacy, transport, doctors and nurses) must act Read more »

Recently, nine patients died in Alabama when they received intravenous nutrition that was contaminated with deadly bacteria. This type of nutrition is called total parenteral nutrition, or TPN, and is used to nourish patients by vein when their digestive systems are not functioning properly. It is a milestone achievement in medicine and saves and maintains lives every day.

What went wrong? How did an instrument of healing become death by lethal injection? What is the lesson that can emerge from this unimaginable horror?

This tragedy represents that most feared ‘never event’ that can ever occur – death by friendly fire. No survivors. Contrast this with many other medical ‘never events’ as defined by the Centers for Medicare and Medicaid Services, such as post-operative infections, development of bed sores in the hospital or wrong-site surgery. Under the ‘never events’ program, hospitals will be financially penalized if a listed event occurs. Many physicians and hospitals are concerned that there will be a ‘never events’ mission creep with new outcomes added to the list that don’t belong there. Medical complications, which are unavoidable, may soon be defined as ‘never events’.

Do we need a new category of ‘never ever ever events’ to include those that lead to fatal outcomes? Read more »

Because current sepsis tests can take up to two days to provide a diagnosis, many patients fail to receive proper treatment until it is too late.

However, researchers at the Fraunhofer Institute for Cell Therapy and Immunology hope to improve survival rates with the MinoLab, a new testing platform which they claim will be able to provide results in under an hour. The MinoLab uses magnetic nanoparticles to carry the analyte through multiple reaction chambers before providing a final diagnosis.

More from the announcement:

Dr. Dirk Kuhlmeier, a scientist at the Fraunhofer Institute for Cell Therapy and Immunology, explains how all that works: “After taking a sample of blood, magnetic nanoparticles bind themselves to the target cells in the blood sample through specific catcher molecules. We then use a simple magnet to transfer the particles onto the plastic card along with the pathogens and move them through various miniaturized reaction chambers which is where the polymerase chain reaction takes place. This is a method for copying even the smallest DNA sequences of pathogens millions of times. After it is copied, the nanoparticles transport the pathogen DNA into the detection chamber where a new type of magnetoresistive biochip can identify pathogens and antibiotics resistances.”

Being South African these days sometimes means we see things in a slightly skewed way. It seems to be the way we have become. I have touched on this before, but there is another story which illustrates the point.

The recent run of hijackings were fresh in all our minds because the perpetrators had shot and killed, execution style, a mother and her three year old child just the previous week. There were reports that one specific gang was working the area and were responsible for most if not all the hijackings and associated killings in the area. So when our patient came in, even before the police told us so, we just assumed he was one of this gang. Read more »

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